The efficacy of everolimus-eluting stent implantation in patients with ST-segment elevation myocardial infarction: outcomes of 2-year clinical follow-up

Abstract

First-generation drug-eluting stents (DES) demonstrated delay in vascular healing and increase in incidence of late and very late stent thrombosis compared with bare-metal stents (BMS). Second-generation DES, however, have shown a reduction of late and very late stent thrombosis compared with first-generation DES. Thus, we decided to evaluate whether the second-generation everolimus-eluting stent (EES) has an advantage over BMS in Japanese patients with ST-segment elevation myocardial infarction (STEMI). This study was conducted in two centers, retrospective, non-randomized and observational design in patients with STEMI. Three-hundred eighty patients were randomly selected to receive EES (198 patients) or cobalt-chromium BMS (182 patients). The primary endpoints were cardiac death, recurrent myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and stent thrombosis (ST). At 2 years, the rates of TLR, TVR, and recurrent MI were significantly lower in the EES group than in the BMS group (TLR 1.5 vs. 8.3 %, p < 0.05; TVR 2.5 vs. 9.4 %, p < 0.05; recurrent MI 1.0 vs. 4.1 %, p < 0.05), and the rate of ST was also significantly lower in the EES group than in the BMS group (0.5 vs. 4.3 %, p < 0.05). Thus, major adverse cardiac events defined at the composite cardiac death, MI, TLR, TVR, or ST were significantly lower in EES group than in BMS group (3.0 vs. 9.9 %, p = 0.008). The rate of cardiac death, however, did not differ between both groups. In STEMI patients, EES may be associated with improved outcomes-specifically, a significant reduction in TVR, ST, and recurrent MI compared to BMS throughout 2 years.

Five-year outcomes after first- and second-generation drug-eluting stent implantation in all patients undergoing percutaneous coronary intervention

“…In this study, the EES group included more complex lesions such as diffuse long lesions, chronic total occlusion, bifurcated lesions, and STEMI lesions, and had a higher prevalence rate of diabetes mellitus and chronic kidney disease than the SES group. It has been reported that EES is more appropriate for the treatment of diffuse long lesions [34], chronic totally occluded lesions using long stents [35], bifurcated lesions [36], STEMI lesions [37] in patients with diabetes mellitus [38], and/or chronic kidney disease [39] compared with non-EES DES.…”

Drug-Eluting Balloon versus New-Generation Drug-Eluting Stent for the Treatment of In-Stent Restenosis

“…New-generation DES, especially EES, is the most common type of DES used in the current interventional practice. [ 30 31 ] EES made of cobalt-chromium or platinum-chromium alloys has a thinner strut than first-generation DES and it also uses a biocompatible fluoropolymer while the paclitaxel-eluting stent uses a durable polymer, which is associated with medial necrosis, positive remodeling, and excessive fibrin deposition. [ 32 ] Previous meta-analysis has shown that the new-generation DES, such as EES or zotarolimus-eluting stent, has improved safety and efficacy than the first-generation DES.…”